Original article 11 -------------
-
Teaching Reading Comprehension Skills to Spina Bifida Children D. Grantl, Ann .A1ooneyl
Summary Thirteen children with spina bifida (mean age 11 11 mths) and a mean reading eomprehension reading defieit of 10.5 mths were enrolled into aremedial programme. The withdrawal single ease study methodology was used (baseline - 5 weeks, treatment - 5 weeks, withdrawal - 12 weeks). Eaeh ehild was seen twice a \veek for 15 minutes during both the baseline and treatment stages. A teaching programme based on a doze teehnique was utilized only during the treatment stage. The teehnique involved teaehing each ehild a strategy for systematieally examining a text for meaning. }TS
A hah'ing of the eomprehension defieit was observed by the end of the treatment stage, with a mean regression of almost 3 months at the end of the withdrav.al stage. No relationship bet\\'een IQ and gains in reading comprehension was obsen'ed. The results may indieate that, in part, reading eomprehension defieits are performance deficits which, in turn, may be mediated by attentional strategies.
Key words Heading skills - Remedial teaching - Spina bifida
A detailed account of the educational attainments of children with spina bifida is readily available (4, 7, 15, 16, 17). It is clear from these reports that while poor educational attainment is related to intellectual ability, this is not the only causal factor. Other factors, such as teacher expectation and/or educational practice mayaIso be important. For example, Tew and Laurence (16) reported that the reading skills of meningocele or myelocele children attending special schools were significantly belo\\' those expected using IQ as a predictor, while Carr, Pearson and Halliwell (4) have reported that children attending special schools in the London area score lower than both their controls and spina bifida children attending ordinary schools on maths and spelling after accounting for IQ. The vie\v that poor educational achievement may reflect other than the direct impact of a hydrocephalic condition is not a new concern. Anderson (1) refers to a collective view that some children are ~underfunctioning' in special schools", a view supported by Dodd (6) \",ho reported that hchildren of equal ability are likely to do better in number \\'ork if they attend ordinary school". HO\\Tever, \\'hile it may be the case that underachievement could reflect lo\\'er teacher - and pupil -
expectations of those working in and attending special schools, differential educational achievement cannot be explained without considering educational techniques. This is implicit in Tew's (17) comments that the performance of some children may be associated \\;th hteachers having positive expectations of pupil achievement working towards specific goals" - and his concern that teachers may lack crucial information to enable them to be effective in assisting spina bifida schoolchildren to reach their potential. This latter point is of crucial importance for remediation of educational disadvantage and its prevention. These depend on more than a knowledge of a child's cognitive deficits and physical disabilities and an achievement-oriented attitude. They also require a kno\\,ledge of pedagogic techniques and their efficacy, an empirical question notable for its almost total absence from the literature. For example, Fay et al (7) provide a detailed overview of educational deficits frequently reported for children with spina bifida (principally writing, spelling, arithmetic, reading). However, their discussion of potential remediation strategies reveals the paucity of knowledge about \\Thether a given strategy is known to be effective. With the exception of Anderson's work (2) on improving hand-writing skins of spina bifida children, there is little empirical evidence to enable informed choices to be made about which pedagogic techniques should be used to develop educational skins. This issue for us became apparent on studying the London data of Carr et al. Irrespective of school type, children \vith spina bifida scored lower on reading comprehension skins than on reading accuracy skills. This observation of a deficit across school types ruled out an explanation in terms of different attitudinal factors between special and ordinary schools. Secondly, an explanation in terms of hydrocephalic condition had to be ruled out as Tew and Laurence (15) had reported negligible differences between reading accuracy and reading comprehension skills for a different spina bifida population. This lack of commonality across populations could be interpreted as implying a potentially remediable deficit, and the major objective of the study reported below was to determine whether a structured approach towards the teaching of reading comprehension skills could improve the reading comprehension skills of spina bifida children.
h
Received J uly 14, 1990 Z Kinderchir 45, Suppl. I (1990) 11-13 C Hippokrates Verlag Stuttgart
Teac~ing ~aterial_s_
I norder to extract meaning from text, there is a consensus (5) that children need to use strategies and that these strategies ean be taught. As our target population \\'as known to be diverse, it was necessary to identify a strategy that eould be adapted to individual needs. The teehnique of requiring readers to identify words deleted from a text has been recommended as a means of improving reading
Downloaded by: Universite Laval. Copyrighted material.
I Faculty of Information Studies, Ealing College, St. !\1ary's Road, London, England \V5 5RF, and 21rvine llniversity, California, lJSA
Z Kinderchir 45, Suppl. 1(1990)
comprehension since at least 1945 (14) though many questions remain about the circumstances under which it can be utilized successfully (9), and cautious authors of teacher trainer manuals draw attention to this lack of knowledge (11, 13). In spite of their caveats, the technique - usually referred to as the doze technique - appeared suitable for use on an individual basis in that eloze texts could be constructed from reading materials that matched the reading level and interests of individual children. In addition, we were aware that many of the children would be of low ability, and]ames (8), in an enthusiastic but subjective account, had reported that he had successfully used a doze technique with children whose IQ was less than 70. As Cambourne (cited in ]ongsma, 9) had reported that backward readers are less effective than above average readers at using search strategies to look for textual information relevant to deleted words, it appeared necessary to adopt a policy which systematically took children through a range of search tactics. Consequently, the teaching programme was sub-divided into four phases: searching for meaning within the sentence in which adeletion occurred; searching back into the text; searching forward into the text; using all three strategies. This policy meant that all texts used by a child had to reflect the search pattern being taught during a specific session. For example, during the early teaching sessions, the child would only have to look through the sentence in which the deletion occurred in order to extract as though a storm doud meaning (eg Suddenly the sky was very covered the sun.). In order to select books from which extracts could be prepared, preliminary visits to the cooperating school were made and a range of books in current use identified. 200 word extracts were selected and typed up in a large script, with sufficient room left for children with poor hand -writing skills to write words in the deleted word spaces.
Methodology A withdrawal design (10) was used. This design requires monitoring target behaviours over three stages - baseline; treatment; withdrawal. Remedial programmes are administered over the course of the treatment stage only, while by withdrawing the programme at the end of this stage and continuing to monitor the target behaviours over the withdrawal stage the stability of these behaviours can be assessed. This design is highly suited to situations where only small numbers of subjects are available and wide diversity exists within the subject pool, thus rendering attempts to create an equivalent control group difficult. An additional advantage is that a possible Hawthorne effect can be controlled for in that the remedial teacher can work for an equal period of time with the subjects over the course of the baseline stage prior to the introduction of the remedial programme. However, the necessity to carry out minimally four assessments carries with it the risk of practice effects. Provided parallel and equivalent forms of the assessment techniques are available, a simple ABAB assessment sequence can be adopted to minimise practice effects. As it was necessary for us to monitor both reading accuracy and reading comprehension for a group of children of widely differing abilities and ages, the only suitable assessment device available was the Neale Analysis of Reading (1968). An additional reason for adopting the Neale is that it provides a measure of reading comprehension without requiring a child to complete "doze" exercises. However, although it is available in several forms, piloting work and elose examination of the manual data revealed that reading comprehension scores, though not the reading accuracy scores, are not equivalent since higher scores for comprehension skills are obtained with form B than with form A. In order to avoid recording spurious changes in comprehension skiBs, both forms (A and B) were administered within the week prior to the start of the baseline stage and a counterbalancing procedure both across and within assessments adopted on the completion of each of the three phases. This procedure thus allowed practice effects
D. Grant and Ann Mooney to be minimised and, by enabling direct comparisons to be made against the first assessment, ensured that changes monitored in target behaviours represented educational practices rather than methodological artefacts. The Reading Levels Test, Experimental Version (1961), a doze instrument, was also administered at each assessment point. Unlike the Neale, this was conducted on a group basis.
Subjects-teaching Fourteen spina bifida children (7 girls, 7 boys), aB drawn from the same school for physically handicapped children, were selected for indusion in the evaluation of the remedial programme, though illness forced the withdrawal of one girl during the baseline stage. Only children with a reading comprehension age equal to or greater than 4 months below reading accuracy were eligible for ind usion. In practice, most children on screening met this criterion. The average age of the children was 11 years 11 months (range 8 to 14 years). Six fuB scales drawn from the British Ability Scales (1978) were administered and mean centile scores calculated: Block Design (Level) 9.8, Matrices 11.3, Similarities 28.2, Verbal Fluency 40.6, Recall 48.3. (As 8 of the 13 children scored zero on Speed of Information Processing a mean centile score could not be calculated). Though IQ scores were calculated giving a mean of 71: (range < 50 to 100) the striking variation across the scales suggest IQ scores for these children are unhelpful in other than a very broad sense. During the 5 week baseline stage the remedial teacher (AM) spent a minimum of 2.5 hours with each child on a one-to-one basis administering the six scales drawn from the British Ability Scales and several experimental versions of the Vernon Graded Spelling Test. These activities required each child to be seen on a regular basis over this stage. During the treatment stage which followed each child was seen twice a week for 15 minutes at a time. The teaching strategy consisted of conducting each child through specially prepared 200 word extracts which reflected both that child 's reading abilities and interests. In the first two sessions the deletions could be resolved by examining the sentence within which the deletion occurred. Subsequent sessions taught the following strategies successively: scan backwards into text, 2 sessions; scan forward into text, 2 sessions; a combination of the above strategies, 4 sessions. On encountering adeletion when reading through an extract, the children were encouraged to supply an appropriate word. If a suitable word could not be supplied the teacher discussed the text with the child and pointed to cues within the text using the designated search strategy. On the other hand, when an appropriate word was supplied, the children were encouraged to think of other words that might be equally appropriate and, in order to emphasise the search strategy, they were asked to underline the words in the text which had helped them to arrive at their choice. Once adeletion had been discussed and resolved, the choice was written in. The withdrawal stage lasted for 12 weeks and induded the summer vacation. There was no contact with the remedial teacher during this stage.
Results Product moment correlations were determined between forms A and B for reading accuracy (r = 0.98) and reading comprehension (r = 0.84). The mean reading accuracy ages observed at the start of the baseline period were 9 yrs 3 mths (form A) and 9 yrs 4 mths (form B), while the corresponding reading comprehension ages were 8 yrs 2 mths and 8 yrs 8 mths respectively. The averaged com prehension deficit is 10.5 mths, and it is this figure that is used for d iscussion and illustrative purposes.
Downloaded by: Universite Laval. Copyrighted material.
12
Teaching Reading Comprehension Skills 10 Spina Bifida Children Readlng com prehenslon deflcit
13
programmes do not usually bring about long-term effecls. However, unlike some remedial programmes, the technique used here is one available to all those involved in the education of children and, given the lack of relationship between IQ and gains in comprehension, children of low and moderate ability may benefit equally from this programme.
15ms '---------r-------~----- - - - -------, TEACHING WITHDRAWAl BASELINE 5 WEEKS 12 WEEKS 5 WEEKS
Changes in reading comprehenslon deflclt over the course of three stages of aremedial programme
In order to calculate changes in comprehension deficits over each stage the follo\\'ing procedure was adopted. The comprehension deficit obtained for a gi"en child at any of the assessment points was compared directly \\'ith the comprehension deficit noted for the appropriate form (i.e. A \\'ith A, B \\'ith B) at the start of the baseline stage. The size and direction of any change was noted and then the figure adjusted to take account of an.y changes that may have occurred in preceding stages. The average comprehension deficit of 10.5 mths at the start of the baseline period was found to have decreased by a marginal 0.53 mths at the end of the baseline period while by the end of the treatment stage it had decreased by a further 4.85 mths. A regression of 2,9 mths was calculated for the withdrawal stage. A comparison of the comprehension deficits at the end of each stage \\'ith those obtained at the start of the ne\\-' baseline period produced a significant difference onIy for those calculated at the end of the treatment period (Sandler's A = 0.286, df 12, p
-
Teaching Reading Comprehension Skills to Spina Bifida Children D. Grantl, Ann .A1ooneyl
Summary Thirteen children with spina bifida (mean age 11 11 mths) and a mean reading eomprehension reading defieit of 10.5 mths were enrolled into aremedial programme. The withdrawal single ease study methodology was used (baseline - 5 weeks, treatment - 5 weeks, withdrawal - 12 weeks). Eaeh ehild was seen twice a \veek for 15 minutes during both the baseline and treatment stages. A teaching programme based on a doze teehnique was utilized only during the treatment stage. The teehnique involved teaehing each ehild a strategy for systematieally examining a text for meaning. }TS
A hah'ing of the eomprehension defieit was observed by the end of the treatment stage, with a mean regression of almost 3 months at the end of the withdrav.al stage. No relationship bet\\'een IQ and gains in reading comprehension was obsen'ed. The results may indieate that, in part, reading eomprehension defieits are performance deficits which, in turn, may be mediated by attentional strategies.
Key words Heading skills - Remedial teaching - Spina bifida
A detailed account of the educational attainments of children with spina bifida is readily available (4, 7, 15, 16, 17). It is clear from these reports that while poor educational attainment is related to intellectual ability, this is not the only causal factor. Other factors, such as teacher expectation and/or educational practice mayaIso be important. For example, Tew and Laurence (16) reported that the reading skills of meningocele or myelocele children attending special schools were significantly belo\\' those expected using IQ as a predictor, while Carr, Pearson and Halliwell (4) have reported that children attending special schools in the London area score lower than both their controls and spina bifida children attending ordinary schools on maths and spelling after accounting for IQ. The vie\v that poor educational achievement may reflect other than the direct impact of a hydrocephalic condition is not a new concern. Anderson (1) refers to a collective view that some children are ~underfunctioning' in special schools", a view supported by Dodd (6) \",ho reported that hchildren of equal ability are likely to do better in number \\'ork if they attend ordinary school". HO\\Tever, \\'hile it may be the case that underachievement could reflect lo\\'er teacher - and pupil -
expectations of those working in and attending special schools, differential educational achievement cannot be explained without considering educational techniques. This is implicit in Tew's (17) comments that the performance of some children may be associated \\;th hteachers having positive expectations of pupil achievement working towards specific goals" - and his concern that teachers may lack crucial information to enable them to be effective in assisting spina bifida schoolchildren to reach their potential. This latter point is of crucial importance for remediation of educational disadvantage and its prevention. These depend on more than a knowledge of a child's cognitive deficits and physical disabilities and an achievement-oriented attitude. They also require a kno\\,ledge of pedagogic techniques and their efficacy, an empirical question notable for its almost total absence from the literature. For example, Fay et al (7) provide a detailed overview of educational deficits frequently reported for children with spina bifida (principally writing, spelling, arithmetic, reading). However, their discussion of potential remediation strategies reveals the paucity of knowledge about \\Thether a given strategy is known to be effective. With the exception of Anderson's work (2) on improving hand-writing skins of spina bifida children, there is little empirical evidence to enable informed choices to be made about which pedagogic techniques should be used to develop educational skins. This issue for us became apparent on studying the London data of Carr et al. Irrespective of school type, children \vith spina bifida scored lower on reading comprehension skins than on reading accuracy skills. This observation of a deficit across school types ruled out an explanation in terms of different attitudinal factors between special and ordinary schools. Secondly, an explanation in terms of hydrocephalic condition had to be ruled out as Tew and Laurence (15) had reported negligible differences between reading accuracy and reading comprehension skills for a different spina bifida population. This lack of commonality across populations could be interpreted as implying a potentially remediable deficit, and the major objective of the study reported below was to determine whether a structured approach towards the teaching of reading comprehension skills could improve the reading comprehension skills of spina bifida children.
h
Received J uly 14, 1990 Z Kinderchir 45, Suppl. I (1990) 11-13 C Hippokrates Verlag Stuttgart
Teac~ing ~aterial_s_
I norder to extract meaning from text, there is a consensus (5) that children need to use strategies and that these strategies ean be taught. As our target population \\'as known to be diverse, it was necessary to identify a strategy that eould be adapted to individual needs. The teehnique of requiring readers to identify words deleted from a text has been recommended as a means of improving reading
Downloaded by: Universite Laval. Copyrighted material.
I Faculty of Information Studies, Ealing College, St. !\1ary's Road, London, England \V5 5RF, and 21rvine llniversity, California, lJSA
Z Kinderchir 45, Suppl. 1(1990)
comprehension since at least 1945 (14) though many questions remain about the circumstances under which it can be utilized successfully (9), and cautious authors of teacher trainer manuals draw attention to this lack of knowledge (11, 13). In spite of their caveats, the technique - usually referred to as the doze technique - appeared suitable for use on an individual basis in that eloze texts could be constructed from reading materials that matched the reading level and interests of individual children. In addition, we were aware that many of the children would be of low ability, and]ames (8), in an enthusiastic but subjective account, had reported that he had successfully used a doze technique with children whose IQ was less than 70. As Cambourne (cited in ]ongsma, 9) had reported that backward readers are less effective than above average readers at using search strategies to look for textual information relevant to deleted words, it appeared necessary to adopt a policy which systematically took children through a range of search tactics. Consequently, the teaching programme was sub-divided into four phases: searching for meaning within the sentence in which adeletion occurred; searching back into the text; searching forward into the text; using all three strategies. This policy meant that all texts used by a child had to reflect the search pattern being taught during a specific session. For example, during the early teaching sessions, the child would only have to look through the sentence in which the deletion occurred in order to extract as though a storm doud meaning (eg Suddenly the sky was very covered the sun.). In order to select books from which extracts could be prepared, preliminary visits to the cooperating school were made and a range of books in current use identified. 200 word extracts were selected and typed up in a large script, with sufficient room left for children with poor hand -writing skills to write words in the deleted word spaces.
Methodology A withdrawal design (10) was used. This design requires monitoring target behaviours over three stages - baseline; treatment; withdrawal. Remedial programmes are administered over the course of the treatment stage only, while by withdrawing the programme at the end of this stage and continuing to monitor the target behaviours over the withdrawal stage the stability of these behaviours can be assessed. This design is highly suited to situations where only small numbers of subjects are available and wide diversity exists within the subject pool, thus rendering attempts to create an equivalent control group difficult. An additional advantage is that a possible Hawthorne effect can be controlled for in that the remedial teacher can work for an equal period of time with the subjects over the course of the baseline stage prior to the introduction of the remedial programme. However, the necessity to carry out minimally four assessments carries with it the risk of practice effects. Provided parallel and equivalent forms of the assessment techniques are available, a simple ABAB assessment sequence can be adopted to minimise practice effects. As it was necessary for us to monitor both reading accuracy and reading comprehension for a group of children of widely differing abilities and ages, the only suitable assessment device available was the Neale Analysis of Reading (1968). An additional reason for adopting the Neale is that it provides a measure of reading comprehension without requiring a child to complete "doze" exercises. However, although it is available in several forms, piloting work and elose examination of the manual data revealed that reading comprehension scores, though not the reading accuracy scores, are not equivalent since higher scores for comprehension skills are obtained with form B than with form A. In order to avoid recording spurious changes in comprehension skiBs, both forms (A and B) were administered within the week prior to the start of the baseline stage and a counterbalancing procedure both across and within assessments adopted on the completion of each of the three phases. This procedure thus allowed practice effects
D. Grant and Ann Mooney to be minimised and, by enabling direct comparisons to be made against the first assessment, ensured that changes monitored in target behaviours represented educational practices rather than methodological artefacts. The Reading Levels Test, Experimental Version (1961), a doze instrument, was also administered at each assessment point. Unlike the Neale, this was conducted on a group basis.
Subjects-teaching Fourteen spina bifida children (7 girls, 7 boys), aB drawn from the same school for physically handicapped children, were selected for indusion in the evaluation of the remedial programme, though illness forced the withdrawal of one girl during the baseline stage. Only children with a reading comprehension age equal to or greater than 4 months below reading accuracy were eligible for ind usion. In practice, most children on screening met this criterion. The average age of the children was 11 years 11 months (range 8 to 14 years). Six fuB scales drawn from the British Ability Scales (1978) were administered and mean centile scores calculated: Block Design (Level) 9.8, Matrices 11.3, Similarities 28.2, Verbal Fluency 40.6, Recall 48.3. (As 8 of the 13 children scored zero on Speed of Information Processing a mean centile score could not be calculated). Though IQ scores were calculated giving a mean of 71: (range < 50 to 100) the striking variation across the scales suggest IQ scores for these children are unhelpful in other than a very broad sense. During the 5 week baseline stage the remedial teacher (AM) spent a minimum of 2.5 hours with each child on a one-to-one basis administering the six scales drawn from the British Ability Scales and several experimental versions of the Vernon Graded Spelling Test. These activities required each child to be seen on a regular basis over this stage. During the treatment stage which followed each child was seen twice a week for 15 minutes at a time. The teaching strategy consisted of conducting each child through specially prepared 200 word extracts which reflected both that child 's reading abilities and interests. In the first two sessions the deletions could be resolved by examining the sentence within which the deletion occurred. Subsequent sessions taught the following strategies successively: scan backwards into text, 2 sessions; scan forward into text, 2 sessions; a combination of the above strategies, 4 sessions. On encountering adeletion when reading through an extract, the children were encouraged to supply an appropriate word. If a suitable word could not be supplied the teacher discussed the text with the child and pointed to cues within the text using the designated search strategy. On the other hand, when an appropriate word was supplied, the children were encouraged to think of other words that might be equally appropriate and, in order to emphasise the search strategy, they were asked to underline the words in the text which had helped them to arrive at their choice. Once adeletion had been discussed and resolved, the choice was written in. The withdrawal stage lasted for 12 weeks and induded the summer vacation. There was no contact with the remedial teacher during this stage.
Results Product moment correlations were determined between forms A and B for reading accuracy (r = 0.98) and reading comprehension (r = 0.84). The mean reading accuracy ages observed at the start of the baseline period were 9 yrs 3 mths (form A) and 9 yrs 4 mths (form B), while the corresponding reading comprehension ages were 8 yrs 2 mths and 8 yrs 8 mths respectively. The averaged com prehension deficit is 10.5 mths, and it is this figure that is used for d iscussion and illustrative purposes.
Downloaded by: Universite Laval. Copyrighted material.
12
Teaching Reading Comprehension Skills 10 Spina Bifida Children Readlng com prehenslon deflcit
13
programmes do not usually bring about long-term effecls. However, unlike some remedial programmes, the technique used here is one available to all those involved in the education of children and, given the lack of relationship between IQ and gains in comprehension, children of low and moderate ability may benefit equally from this programme.
15ms '---------r-------~----- - - - -------, TEACHING WITHDRAWAl BASELINE 5 WEEKS 12 WEEKS 5 WEEKS
Changes in reading comprehenslon deflclt over the course of three stages of aremedial programme
In order to calculate changes in comprehension deficits over each stage the follo\\'ing procedure was adopted. The comprehension deficit obtained for a gi"en child at any of the assessment points was compared directly \\'ith the comprehension deficit noted for the appropriate form (i.e. A \\'ith A, B \\'ith B) at the start of the baseline stage. The size and direction of any change was noted and then the figure adjusted to take account of an.y changes that may have occurred in preceding stages. The average comprehension deficit of 10.5 mths at the start of the baseline period was found to have decreased by a marginal 0.53 mths at the end of the baseline period while by the end of the treatment stage it had decreased by a further 4.85 mths. A regression of 2,9 mths was calculated for the withdrawal stage. A comparison of the comprehension deficits at the end of each stage \\'ith those obtained at the start of the ne\\-' baseline period produced a significant difference onIy for those calculated at the end of the treatment period (Sandler's A = 0.286, df 12, p
